Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Brief Communication
Cardiac Critical Care, Case Report
Cardiac Critical Care, Case Series
Cardiac Critical Care, Editorial
Cardiac Critical Care, Invited Editorial
Cardiac Critical Care, Original Article
Cardiac Critical Care, Point of Technique
Cardiac Critical Care, Review Article
Case Report
Case Report, Cardiac Critical Care
Case Series, Cardiac Critical Care
Editorial
Editorial, Cardiac Critical Care
Invited Editorial, Cardiac Critical Care
JCCC Quiz, Cardiac Critical Care
Legends in Cardiac Sciences
Letter To Editor Response
Letter to Editor, Cardiac Anesthesia
Letter to Editor, Cardiac Critical Care
Letter to the Editor
Narrative Review, Cardiac Critical Care
Original Article
Original Article, Cardiac Critical Care
Original Article, Cardiology
Perspective Insights
Perspective, Cardiac Critical Care
Point of Technique
Point of Technique, Cardiac Critical Care
Point of View, Cardiac Critical Care
Review Article
Review Article, Cardiac Critical Care
Review Article, Cardiology
Review Article, Evidence Based Medicine
Review Article, Invited
Short Communication, Cardiac Critical Care
Surgical Technique
Surgical Technique, Cardiology
Systematic Review
Technical Note
Video Case Report
Video Commentary
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Brief Communication
Cardiac Critical Care, Case Report
Cardiac Critical Care, Case Series
Cardiac Critical Care, Editorial
Cardiac Critical Care, Invited Editorial
Cardiac Critical Care, Original Article
Cardiac Critical Care, Point of Technique
Cardiac Critical Care, Review Article
Case Report
Case Report, Cardiac Critical Care
Case Series, Cardiac Critical Care
Editorial
Editorial, Cardiac Critical Care
Invited Editorial, Cardiac Critical Care
JCCC Quiz, Cardiac Critical Care
Legends in Cardiac Sciences
Letter To Editor Response
Letter to Editor, Cardiac Anesthesia
Letter to Editor, Cardiac Critical Care
Letter to the Editor
Narrative Review, Cardiac Critical Care
Original Article
Original Article, Cardiac Critical Care
Original Article, Cardiology
Perspective Insights
Perspective, Cardiac Critical Care
Point of Technique
Point of Technique, Cardiac Critical Care
Point of View, Cardiac Critical Care
Review Article
Review Article, Cardiac Critical Care
Review Article, Cardiology
Review Article, Evidence Based Medicine
Review Article, Invited
Short Communication, Cardiac Critical Care
Surgical Technique
Surgical Technique, Cardiology
Systematic Review
Technical Note
Video Case Report
Video Commentary
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Brief Communication
Cardiac Critical Care, Case Report
Cardiac Critical Care, Case Series
Cardiac Critical Care, Editorial
Cardiac Critical Care, Invited Editorial
Cardiac Critical Care, Original Article
Cardiac Critical Care, Point of Technique
Cardiac Critical Care, Review Article
Case Report
Case Report, Cardiac Critical Care
Case Series, Cardiac Critical Care
Editorial
Editorial, Cardiac Critical Care
Invited Editorial, Cardiac Critical Care
JCCC Quiz, Cardiac Critical Care
Legends in Cardiac Sciences
Letter To Editor Response
Letter to Editor, Cardiac Anesthesia
Letter to Editor, Cardiac Critical Care
Letter to the Editor
Narrative Review, Cardiac Critical Care
Original Article
Original Article, Cardiac Critical Care
Original Article, Cardiology
Perspective Insights
Perspective, Cardiac Critical Care
Point of Technique
Point of Technique, Cardiac Critical Care
Point of View, Cardiac Critical Care
Review Article
Review Article, Cardiac Critical Care
Review Article, Cardiology
Review Article, Evidence Based Medicine
Review Article, Invited
Short Communication, Cardiac Critical Care
Surgical Technique
Surgical Technique, Cardiology
Systematic Review
Technical Note
Video Case Report
Video Commentary
View/Download PDF

Translate this page into:

Editorial
6 (
1
); 05-06
doi:
10.1055/s-0041-1739526

Nutrition in ICU Patients

Department of Critical Care and Anaesthesiology, Medanta – The Medicity, Gurugram, Haryana, India
Address for correspondence Yatin Mehta, MBBS, MD, MNAMS, FRCA, FAMS, FIACTA, FICCM, FTEE Department of Critical Care and Anaesthesiology, Medanta – The Medicity Sector 38, Gurugram 120001, Haryana India yatinmehta@hotmail.com
Licence
This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Stress catabolism and systemic inflammatory response is ubiquitous in critically ill patients. Multiorgan failure, various morbidities, and higher length of stay are commonly seen in the critically ill, especially in the current pandemic context. Nutritional importance in such critical-care settings is immense. Adequate nutrition care helps overcome the stress response and modulates the both innate and adoptive immunity favorably, loss of body muscle mass is attenuated, and metabolic complications are also controlled. Reduced morbidity rates, length of hospital stay, and better patient outcomes in patients with adequate nutrition care have made the nutrition support worthy in critical care settings, and are no more considered as adjunct but are therapeutic.1

Various physiometabolic changes due to critical illness increase the risk of patient becoming malnourished, which creates a vicious cycle and exacerbates the stress response. Inadequate daily calories/protein intake complicates it further. Early initiation of enteral nutrition (EN), within 24 to 48 hour of illness, is associated with significant benefits.2, 3 This can be done orally or via tube feeding, depending on achievement of nutritional adequacy goals.

Mesenteric ischemia and ileus are common, and hence monitoring gut function remains essential throughout the nutrition care. EN should be started in volume resuscitated patients, who are on stable/declining doses of vasopressors, but not in patients in shock. Starting feeding with trophic volumes (10–20 mL/h) is advisable and then gradually increasing it to meet 70% of target in 72 hours.1, 2

Nutritional assessment done before starting feeding care forms an important part of nutrition care and should be done early. Available simple tools like subjective global assessment can be preferred in resource-limited settings. Use of nutrition risk screening (NRS) 2002 or nutrition risk in critically ill (NUTRIC) score can be preferred for nutritional assessment, if feasible.1

Decision on how much to feed is very important. Indirect calorimetry remains the gold standard for measuring energy requirements. Anthropometrics-based predictions are inaccurate. Simplistic weight-based equations can be used, as per the existing literature. The recommendations for daily calories/proteins change if the patient is obese.1, 3 High energy (25–30 Kcal/kg/day)/proteins (1.2–1.5 gm/kg/day) are recommended in nonobese patients.1 Both underfeeding and overfeeding should be avoided. Early aggressive feeding may result in refeeding syndrome in malnourished critically ill patients.

Existing guidelines recommend initiating feeds via enteral route, unless contraindicated. It is more physiologic and helps to maintain structural–functional integrity of gut and symbiotic gut microbes are preserved. In cases of nutrition inadequacy with enteral routes, parenteral route can be utilized. Overfeeding, hyperglycemia, and infectious complications are key challenges, seen with parenteral nutrition.4 Enteral feeding can be done via nasogastric, nasojejunal, or gastrostomy routes. Feed-related infections can be prevented by maintaining the hygiene and microbial safety of feeds.5

Continuous monitoring of nutritional tolerance is required. Factors affecting the desired nutrition goals in terms of total volume, energy, proteins, etc. should be identified and documented. Daily monitoring helps to improve tolerance. In all unconscious or ventilated or other high-risk patients, gastric residual volume (GRV) should be monitored 6 to 8 hourly with GRV below 300 mL considered as safe. Continuous feeding is recommended in above-mentioned patients.1

Micronutrient deficiencies are also evident in such patients because of preexisting malnutrition and polypharmacy.6 Micronutrient deficiencies manifest as immune-depletion, poor wound healing, and higher morbidity/mortality. Hence, assessment of preexisting micronutrients' deficiency should be done.1

Severe acute respiratory syndrome coronavirus 2-induced respiratory failure has affected the entire world and majority of critical care settings beds are occupied by these patients. Good supportive care remains the cornerstone in managing critically ill patients with coronavirus disease 2019 (COVID-19). Timely and appropriate nutrition intervention remains an integral component. The nutritional management in critically ill COVID-19 patient should be like any other critically ill patient with respiratory failure.

In our country, there is nonuniformity of nutritional protocols to guide the practice and this has resulted in nutritional inadequacy, causing prolonged malnutrition, higher morbidity, increased stay in intensive care unit (ICU), and adverse clinical outcomes.1 To maintain high standards of nutrition care, documentation of nutrition practices starting from nutritional diagnosis, assessment, intervention, and monitoring should be done. Couple of recent Indian guidelines (published in 2018 and 2019, respectively) on critical care nutrition published in Indian Journal of Critical Care Medicine faculties have tried to fill the gap in practical nutrition in our ICUs. These guidelines should be the guiding principles for nutrition intervention in our critical care settings.

Conflict of Interest

None declared.

References

  1. , , , et al . Practice guidelines for nutrition in critically ill patients: a relook for Indian scenario. Indian J Crit Care Med. 2018;22(4):263-273.
    [Google Scholar]
  2. , , , , . Early enteral nutrition in critically ill patients with hemodynamic instability: an evidence-based review and practical advice. Nutr Clin Pract. 2014;29(1):90-96.
    [Google Scholar]
  3. , , , et al , , . Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.
    [Google Scholar]
  4. , , , et al . Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;20(1):117.
    [Google Scholar]
  5. , , , et al . Bacterial contamination of blenderized whole food and commercial enteral tube feedings in the Philippines. J Hosp Infect. 2001;49(4):268-273.
    [Google Scholar]
  6. , , , , , . Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis. Crit Care. 2012;16(2):R66.
    [Google Scholar]

Fulltext Views
530

PDF downloads
202
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections